Pennsylvania Insurance Commissioner Teresa Miller was the recent state official to suggest protections for healthcare customers against unexpected balance bills, when she declared new measures on the day of Tuesday.
Unexpected balance bills appear when a customer acquires emergency care, or has made a good-faith attempt to use contributors and services in their insurance network, but surprisingly receives a facility from an out-of-network contributor or facility, then acquires a bill.
The objective of Miller's proposal is to take customers out of billing conflicts between insurers and contributors. Her department is looking to work cooperatively with the General Assembly, customers, and stakeholder groups to draft legislation on the problem.
Her policy would protect customers who seek healthcare at in-network services, or from in-network contributors, from being billed by an out-of-network contributor at a cost more than what they would owe to a contributor for any in-network cost sharing under the customer's health policy.
For instance, if a customer's health insurance policy has a $50 co-pay for some service delivered by an in-network contributor, that customer would not be liable for more than $50 for that similar service from an out-of-network contributor.
"At a public hearing in the month of October, I heard from customers who, despite their best attempts to use contributors in their health insurance network, still acquired out-of-network bills that were in the hundreds -- and in few cases, thousands -- of dollars," stated Miller.
It is a common issue, at least in accordance to the Consumer Reports National Research Center. In the month of March 2015, the agency polled more than 2,000 customers online and discovered 37% had received a bill toward which their insurance policy paid less than expected. One quarter of those surprises came from a doctor they did not consider was out of their network.
There is little precedent for Miller's policy. On the month of April 1, 2015, a law took effect in the city of New York which secures patients from owning more than their in-network copayment, coinsurance or deductible on bills they acquire for out-of-network emergency facilities or on surprise bills.
Under the New York Law, when customers get unexpected bills, they require to complete an "assignment of profits" form that permits the contributor to pursue payment from the health policy, and then send the form and the bill to their policy and contributor. As long as they have taken that step, they will not be responsible for any charges beyond their regular in-network cost sharing.
The law also sets up an independent conflict resolution procedure for contributors and health policies to settle on a fee for emergency services or unexpected bills. The independent reviewers’ thinks contributors experience and training, case complexity, sufferer characteristics and commom and customary charges in making a determination, which is binding.
The Pennsylvania proposal would offer numerous options for insurers and contributors to reach agreement on payment, and if they cannot, the matter would go to arbitration. Both sides would submit their offers with reinforcing documentation, and the arbitrator's decision would be binding.
In no case would the customer be liable for anything beyond the cost-sharing due for the service if it had been rendered by an in-network contributor.
Miller stated that the open comment procedure, which will be managed on October 1, 2016 from 10am to 1pm, will permit her department to get input from numerous stakeholders, involving insurers, hospitals, and health care contributors. These significant players also testified at the Insurance Department's public hearing on this topic in the month of October. Written testimony can also be emailed to the Insurance Department's Consumer Liaison.
No comments:
Post a Comment